Life Cycle Cost Analysis (LCCA) provides a systematic approach to assess the total cost associated with owning, operating, and maintaining assets throughout their entire life. BIM empowers architects and designers to ...Life Cycle Cost Analysis (LCCA) provides a systematic approach to assess the total cost associated with owning, operating, and maintaining assets throughout their entire life. BIM empowers architects and designers to perform real-time evaluations to explore various design options. However, when integrated with LCCA, BIM provides a comprehensive economic perspective that helps stakeholders understand the long-term financial implications of design decisions. This study presents a methodology for developing a model that seamlessly integrates BIM and LCCA during the conceptual design stage of buildings. This integration allows for a comprehensive evaluation and analysis of the design process, ensuring that the development aligns with the principles of low carbon emissions by employing modular construction, 3D concrete printing methods, and different building design alternatives. The model considers the initial construction costs in addition to all the long-term operational, maintenance, and salvage values. It combines various tools and data through different modules, including energy analysis, Life Cycle Assessment (LCA), and Life Cycle Cost Analysis (LCCA) to execute a comprehensive assessment of the financial implications of a specific design option throughout the lifecycle of building projects. The development of the said model and its implementation involves the creation of a new plug-in for the BIM tool (i.e., Autodesk Revit) to enhance its functionalities and capabilities in forecasting the life-cycle costs of buildings in addition to generating associated cash flows, creating scenarios, and sensitivity analyses in an automatic manner. This model empowers designers to evaluate and justify their initial investments while designing and selecting potential construction methods for buildings, and enabling stakeholders to make informed decisions by assessing different design alternatives based on long-term financial considerations during the early stages of design.展开更多
DNA methylation has been extensively investigated in recent years,not least because of its known relationship with various diseases.Progress in analytical methods can greatly increase the relevance of DNA methylation ...DNA methylation has been extensively investigated in recent years,not least because of its known relationship with various diseases.Progress in analytical methods can greatly increase the relevance of DNA methylation studies to both clinical medicine and scientific research.Microflu-idic chips are excellent carriers for molecular analysis,and their use can provide improvements from multiple aspects.On-chip molecular analysis has received extensive attention owing to its advantages of portability,high throughput,low cost,and high efficiency.In recent years,the use of novel microfluidic chips for DNA methylation analysis has been widely reported and has shown obvious superiority to conventional methods.In this review,wefirst focus on DNA methylation and its applications.Then,we discuss advanced microfluidic-based methods for DNA methylation analysis and describe the great progress that has been made in recent years.Finally,we summarize the advantages that microfluidic technology brings to DNA methylation analysis and describe several challenges and perspectives for on-chip DNA methylation analysis.This review should help researchers improve their understanding and make progress in developing microfluidic-based methods for DNA methylation analysis.展开更多
Textile dyes are dramatic sources of pollution and non-aesthetic disturbance of aquatic life and therefore represent a potential risk of bioaccumulation that can affect living species.It is imperative to reduce or eli...Textile dyes are dramatic sources of pollution and non-aesthetic disturbance of aquatic life and therefore represent a potential risk of bioaccumulation that can affect living species.It is imperative to reduce or eliminate these dyes from liquid effluents with innovative biomaterials and methods.Therefore,this research aims to highlight the performance of Capparis spinosa L waste-activated carbon(CSLW-AC)adsorbent to remove crystal violet(CV)from an aqueous solution.The mechanism of CV adsorption on CSLW-AC was evaluated based on the coupling of experimental data and different characterization techniques.The efficiency of the CSLW-AC material reflected by the equilibrium adsorption capacity of CV could reach more than 195.671 mg·g^(–1) when 0.5 g·L^(–1) of CSLW-AC(Particle size≤250μm)is introduced into the CV of initial concentration of 100 mg·L^(–1) at pH 6 and temperature 65℃ and in the presence of potassium ions after 60 min of contact time according to the one parameter at a time studies.The adsorption behavior of CV on CSLW-AC was found to be consistent with the pseudo-second-order kinetic model and Frumkin's linear isothermal model.The thermodynamic aspects indicate that the process is physical,spontaneous,and endothermic.The optimization of the process by the Box Behnken design of experiments resulted in an adsorption capacity approaching 183.544 mg·g^(–1)([CV]=100 mg·L^(–1) and[CSLW-AC]=0.5 g·L^(–1) at 35 min).The results of the Lactuca sativa seeds germination in treated CV(70%),adsorbent solvent and thermal regeneration(more than 5 cycles),and process cost analysis(1.0484 USD·L^(–1))tests are encouraging and promising for future exploitations of the CSLW-AC material in different industrial fields.展开更多
AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure(IOP) reduction($/mm Hg).METHODS: Representative index studies were reviewed to quanti...AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure(IOP) reduction($/mm Hg).METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction($/mm Hg) at 1y postoperatively.RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy, $284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy, $338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant, $351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy.CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method.展开更多
BACKGROUND Laparoscopic Heller myotomy(LHM)has been the traditional surgical treatment for achalasia.Recently,peroral endoscopic myotomy(POEM)has demonstrated similar clinical outcomes with shorter procedure times.Stu...BACKGROUND Laparoscopic Heller myotomy(LHM)has been the traditional surgical treatment for achalasia.Recently,peroral endoscopic myotomy(POEM)has demonstrated similar clinical outcomes with shorter procedure times.Studies comparing the direct cost-effectiveness of POEM vs LHM are limited.AIM To compare costs of POEM vs LHM.METHODS Haider SA et al.Comparing costs:POEM vs Heller myotomy WJGE https://www.wjgnet.com 594 October 16,2023 Volume 15 Issue 10 This retrospective chart review aimed to compare the outcomes and cost of clinical care between patients who underwent POEM and LHM procedures for achalasia.The study was conducted at a tertiary academic center from January 2019 to December 2020.Clinical outcomes,including post-operative Eckardt scores and adverse events,were assessed and compared between the two groups.Direct cost variance analysis was utilized to evaluate the cost of clinical care incurred by patients undergoing POEM in the year preceding the procedure,during the index admission,and one year post-procedure,in comparison to patients undergoing LHM.RESULTS Of 30 patients were included(15 POEM and 15 LHM)in the study.Patients in the POEM group had a mean Eckardt score of 0.5±0.5 post-procedure,which was no different from patients in the LHM group(0.7±0.6,P=0.17)indicating comparative efficacy.However,the total costs of the admission for the procedure in the LHM group were on average$1827 more expensive than in the POEM group(P<0.01).Total healthcare costs one year prior to index procedure were$7777 higher in the LHM group,but not statistically different(P=0.34).The patients in the LHM group one year after the index procedure had accrued$19730.24 larger total cost,although this was not statistically different from POEM group(P=0.68).CONCLUSION Despite similar clinical outcomes,the cost of the index procedure admission for POEM was significantly lower than for LHM.The difference was primarily related to shorter time increments utilized in the operating room during the index procedure,and shorter length of hospital stay following POEM.展开更多
Pavement performance and economic efficiency are researched on the perpetual test pavement of Yijiang-Suzhou Express Highway in Jiangsu province, China. Test sections were continuously monitored. The conditions and de...Pavement performance and economic efficiency are researched on the perpetual test pavement of Yijiang-Suzhou Express Highway in Jiangsu province, China. Test sections were continuously monitored. The conditions and developing laws of deflection, rutting and cracking are compared among the perpetual pavement with the rich binder layer (RBL), the perpetual pavement without the RBL, and the conventional semi-rigid asphalt pavement in the past eight years after opening for traffic. Economical evaluation is conducted via life cycle cost analysis (LCCA). Based on the performance comparison and LCCA analysis, sections with the RBL have good crack resistance, but they are not very satisfactory in the aspect of permanent deformation; the conventional semi-rigid asphalt pavement is the least economic one due to requiring more frequent maintenance. Research results show that the perpetual pavement without RBL is a more appropriate structure for the test site.展开更多
Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of ...Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.展开更多
In this paper,a new price is given to the online decision maker at the beginning of each day.The trader must decide how many items to purchase according to the current price.We present three variants and an online alg...In this paper,a new price is given to the online decision maker at the beginning of each day.The trader must decide how many items to purchase according to the current price.We present three variants and an online algorithm based on cost function.The competitive ratio of the online algorithm is given for each variant,which is a performance measure of an online algorithm.More importantly,we show that the online algorithm is optimal.展开更多
AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations.METHODS: Following institutional board approval, we performed a retrospective ...AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations.METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level Ⅰ trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation(LOI), patients were divided in three groups(Group I, < 2 wk; Group Ⅱ, 2-3 wk; and Group Ⅲ, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100°(from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed.RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d(median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d(median 57 d; range 10-351 d). Group Ⅲ(prolonged immobilisation) had a statistically significant worse outcome in comparison to Group Ⅰ?and Ⅱ(P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups Ⅰ?and Ⅱ(P = 0.30). No statistically significantdifference in the direct medical costs between the groups was identified.CONCLUSION: The length of elbow immobilization doesn't influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome.展开更多
Accurate cost estimation at the early stage of a construction project is key factor in a project’s success. But it is difficult to quickly and accurately estimate construction costs at the planning stage, when drawin...Accurate cost estimation at the early stage of a construction project is key factor in a project’s success. But it is difficult to quickly and accurately estimate construction costs at the planning stage, when drawings, documentation and the like are still incomplete. As such, various techniques have been applied to accurately estimate construction costs at an early stage, when project information is limited. While the various techniques have their pros and cons, there has been little effort made to determine the best technique in terms of cost estimating performance. The objective of this research is to compare the accuracy of three estimating techniques (regression analysis (RA), neural network (NN), and support vector machine techniques (SVM)) by performing estimations of construction costs. By comparing the accuracy of these techniques using historical cost data, it was found that NN model showed more accurate estimation results than the RA and SVM models. Consequently, it is determined that NN model is most suitable for estimating the cost of school building projects.展开更多
Agroforestry and beekeeping are widely promoted as prospective Nature-</span></span><span><span><span style="font-family:""> </span></span></span><span...Agroforestry and beekeeping are widely promoted as prospective Nature-</span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Based Income Generating Activities (NIGAs) to improve livelihoods while at </span><span style="font-family:Verdana;">the same time enhancing biodiversity conservation in degrading</span><span style="font-family:Verdana;"> agro-ecologies. These activities can diversify and increase famers’ incomes and support in</span><span style="font-family:Verdana;">stinctive biota and fauna resilience. However, evidence to showcase and compare their long-term benefits is scant. We use the case of Uluguru</span><span style="font-family:Verdana;"> Mountains in Tanzania to evaluate and compare viability of agroforestry and beekeeping projects using the Cost</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Benefit Analysis (CBA) approach. The results of analysis yielded positive NPVs for both agroforestry and beekeeping projects at discount rates not higher than 8.2% and 8.5% respectively. Overall, the comparison of economic viability between agroforestry and beekeeping projects revealed that the former was relatively more profitable than the later in terms of both the NPV and Benefit</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Cost Ratio (BCR) criteria. However, the Internal Rate of Return (IRR) for beekeeping was slightly higher than that of agroforestry. Yet, we underscore the fact that these two projects can jointly be implemented to enhance livelihoods of farmers and support biodiversity conservation in the study </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">area </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and other parts with similar agro-ecologies in developing countries. However, farmers in these agro-ecologies need to be supported by governments and non-government development partners in terms of training and inspiration to shift from orthodox farming to sustainable NIGAs.展开更多
Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected anim...Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.展开更多
This study analyzes the sample influx (samples per case file) into forensic science laboratory (FSL) and the corresponding analysis costs and uses arbitrary re-sampling plans to establish the minimum cost function. Th...This study analyzes the sample influx (samples per case file) into forensic science laboratory (FSL) and the corresponding analysis costs and uses arbitrary re-sampling plans to establish the minimum cost function. The demand for forensic analysis increased for all disciplines, especially biology/DNA between 2014 and 2015. While the average distribution of case files was about 42.5%, 40.6% and 17% for the three disciplines, the distribution of samples was rather different being 12%, 82.5% and 5.5% for samples requiring forensic biology, chemistry and toxicology analysis, respectively. Results show that most of the analysis workload was on forensic chemistry analysis. The cost of analysis for case files and the corresponding sample influx varied in the ratio of 35:6:1 and 28:12:1 for forensic chemistry, biology/DNA and toxicology for year 2014 for 2015, respectively. In the two consecutive years, the cost for forensic chemistry analysis was comparatively very high, necessitating re-sampling. The time series of sample influx in all disciplines are strongly stochastic, with higher magnitude for chemistry, biology/DNA and toxicology, in this order. The PDFs of sample influx data are highly skewed to the right, especially forensic toxicology and biology/DNA with peaks at 1 and 3 samples per case file. The arbitrary re-sampling plans were best suited to forensic chemistry case files (where re-sampling conditions apply). The locus of arbitrary number of samples to take from the submitted forensic samples was used to establish the minimum and scientifically acceptable samples by applying minimization function developed in this paper. The cost minimization function was also developed based on the average cost per sample and choice of re-sampling plans depending on the range of sample influx, from which the savings were determined and maximized. Thus, the study gives a forensic scientist a business model and scientific decision making tool on minimum number of samples to analyze focusing on savings on analysis cost.展开更多
Implementing effective cost management approaches has recently gained momentum due to intense competition and increasing customer demands. Moreover, effective cost management approaches have contributed to firms' com...Implementing effective cost management approaches has recently gained momentum due to intense competition and increasing customer demands. Moreover, effective cost management approaches have contributed to firms' competitive advantage in relation to cost leadership strategy. Consequently, firms have implemented contemporary cost management systems, such as activity-based management, business process re-engineering, life-cycle costing, target costing, and theory of constraint (TOC), to enable them to become low-cost producers and compete effectively and sustain their performance. Furthermore, focusing on cost management to improve profitability has led to the integration of activity-based costing (ABC) and TOC. Therefore, the aim of this study is to review literature and discuss how integration of ABC and TOC can result in improved and sustained cost management. While these methods have different approaches in addressing cost management, treating them as complementary cost management approaches can result in improved cost management due to improved product costing, improved cost reporting, improved product-mix decisions, and improved cycle-time management. Improvement in cost management will then result in sustained cost management. Sustained cost management is further enhanced with the investment in information customer and shareholder value technology that supports cross-functional decision making to continue creating to remain competitive in the market.展开更多
Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups)...Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups). Results from the output-oriented BCC model show that Treatment 4 ( 600 mg of zidovudine plus 400 mg of didanosine plus 400 mg of nevirapine) is particularly efficient for age group 14—25, but not efficient for the older age groups; Treatment 1 (600 mg of zidovudine alternating monthly with 400 mg of didanosine)and Treatment 2 (600 mg of zidovudine plus 2.25 mg of zalcitabine) are efficient for the age groups 35—45 and 45— ; age group 25—35 does not have a particularly efficient treatment, but Treatments 1 and 2 are relatively good. The cost efficiency BCC model, which takes the treatment cost into account, gives similar results as the output-oriented model. Results from the indirect output-oriented BCC model, which allows the replacement among medicines, show that the efficiency of Treatment 2 has greatly decreased compared with that of the output-oriented model, and a set of optimal medicine amounts for different age groups is obtained.展开更多
Parabolic trough collectors (PTCs) are employed for a variety of applications including steam generation and hot water generation. This paper deals with the experimental results and an economic analysis of a new fib...Parabolic trough collectors (PTCs) are employed for a variety of applications including steam generation and hot water generation. This paper deals with the experimental results and an economic analysis of a new fibre reinforced plastic (FRP) based solar PTC with an embedded electronic controlled tracking system designed and developed for hot water generation in a restaurant in Madurai, India. The new collector performance has been tested according to ASHRAE Standard 93 (1986). The performance of a new PTC hot water generation system with a well mixed hot water storage tank is investigated by a series of extensive tests over ten months period. The average maximum storage tank water temperature observed was 74.91℃, when no energy is withdrawn from the tank to the load during the collection period. The total cost of the new economic FRP based solar PTC for hot water generation with an embedded electronic controlled tracking system is Rs. 25000 (US$ 573) only. In the present work, life cycle savings (LCS) method is employed for a detailed economic analysis of the PTC system. A computer program is used as a tool for the economic analysis. The present worth of life cycle solar savings is evaluated for the new solar PTC hot water generation system that replaces an existing electric water heating system in the restaurant and attains a value of Rs. 23171.66 after 15 years, which is a significant saving. The LCS method and the MATLAB computer simulation program presented in this paper can be used to estimate the LCS of other renewable energy systems.展开更多
Scaling up clean hydrogen supply in the near future is critical to achieving China’s hydrogen development target.This study established an electrolytic hydrogen development mechanism considering the generation mix an...Scaling up clean hydrogen supply in the near future is critical to achieving China’s hydrogen development target.This study established an electrolytic hydrogen development mechanism considering the generation mix and operation optimization of power systems with access to hydrogen.Based on the incremental cost principle,we quantified the provincial and national clean hydrogen production cost performance levels in 2030.The results indicated that this mechanism could effectively reduce the production cost of clean hydrogen in most provinces,with a national average value of less than 2 USD·kg^(-1) at the 40-megaton hydrogen supply scale.Provincial cooperation via power transmission lines could further reduce the production cost to 1.72 USD·kg^(-1).However,performance is affected by the potential distribution of hydrogen demand.From the supply side,competitiveness of the mechanism is limited to clean hydrogen production,while from the demand side,it could help electrolytic hydrogen fulfil a more significant role.This study could provide a solution for the ambitious development of renewables and the hydrogen economy in China.展开更多
Excessive consumption of refined grains harms human health and ecosystem viability.Whole grains,as a healthy and sustainable alternative to refined grains,can benefit individual health by providing dietary fiber,B vit...Excessive consumption of refined grains harms human health and ecosystem viability.Whole grains,as a healthy and sustainable alternative to refined grains,can benefit individual health by providing dietary fiber,B vitamins,and bioactive substances.Additionally,they aid in improving the environment due to their higher extraction rate and lower carbon emission during the processing stage.However,few studies have attempted to evaluate the economic and social benefits of increasing the amount of whole grain in grain intake.This paper estimates the potential savings in healthcare costs and reduced food carbon footprints(CFs)that could result from a shift toward whole grain consumption following the Chinese Dietary Guidelines(CDG).We investigate hypothetical scenarios where a certain proportion(5–100%)of Chinese adults could increase their whole grain intakes as proposed by CDG to meet the average shortfall of 30.2 g.In that case,the healthcare costs for associated diseases(e.g.,type2 diabetes mellitus(T2DM),cardiovascular disease(CVD),and colorectal cancer(CRC))are expected to reduce by a substantial amount,from USD 2.82 to 56.37 billion;the carbon emission levels are also projected to decrease by0.24–5.72 million tons.This study provides compelling evidence that advocating for the transition towards greater consumption of whole grain products could benefit individual health,the environment,and society,by reducing both healthcare costs and carbon emissions.展开更多
AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid(TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb ...AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid(TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients(control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients(TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken. RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender(P = 0.47), proportion of total hip replacement to total knee replacement(P = 0.25) or pre-operative haemoglobin(P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2%(P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group(P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group(P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.展开更多
文摘Life Cycle Cost Analysis (LCCA) provides a systematic approach to assess the total cost associated with owning, operating, and maintaining assets throughout their entire life. BIM empowers architects and designers to perform real-time evaluations to explore various design options. However, when integrated with LCCA, BIM provides a comprehensive economic perspective that helps stakeholders understand the long-term financial implications of design decisions. This study presents a methodology for developing a model that seamlessly integrates BIM and LCCA during the conceptual design stage of buildings. This integration allows for a comprehensive evaluation and analysis of the design process, ensuring that the development aligns with the principles of low carbon emissions by employing modular construction, 3D concrete printing methods, and different building design alternatives. The model considers the initial construction costs in addition to all the long-term operational, maintenance, and salvage values. It combines various tools and data through different modules, including energy analysis, Life Cycle Assessment (LCA), and Life Cycle Cost Analysis (LCCA) to execute a comprehensive assessment of the financial implications of a specific design option throughout the lifecycle of building projects. The development of the said model and its implementation involves the creation of a new plug-in for the BIM tool (i.e., Autodesk Revit) to enhance its functionalities and capabilities in forecasting the life-cycle costs of buildings in addition to generating associated cash flows, creating scenarios, and sensitivity analyses in an automatic manner. This model empowers designers to evaluate and justify their initial investments while designing and selecting potential construction methods for buildings, and enabling stakeholders to make informed decisions by assessing different design alternatives based on long-term financial considerations during the early stages of design.
基金support from the National Key R&D Program of China(Grant No.2018YFE0118700)the National Natural Science Foundation of China(NSFC Grant No.62174119)+1 种基金the 111 Project(Grant No.B07014)the Foundation for Talent Scientists of Nanchang Institute for Microtechnology of Tianjin University.
文摘DNA methylation has been extensively investigated in recent years,not least because of its known relationship with various diseases.Progress in analytical methods can greatly increase the relevance of DNA methylation studies to both clinical medicine and scientific research.Microflu-idic chips are excellent carriers for molecular analysis,and their use can provide improvements from multiple aspects.On-chip molecular analysis has received extensive attention owing to its advantages of portability,high throughput,low cost,and high efficiency.In recent years,the use of novel microfluidic chips for DNA methylation analysis has been widely reported and has shown obvious superiority to conventional methods.In this review,wefirst focus on DNA methylation and its applications.Then,we discuss advanced microfluidic-based methods for DNA methylation analysis and describe the great progress that has been made in recent years.Finally,we summarize the advantages that microfluidic technology brings to DNA methylation analysis and describe several challenges and perspectives for on-chip DNA methylation analysis.This review should help researchers improve their understanding and make progress in developing microfluidic-based methods for DNA methylation analysis.
文摘Textile dyes are dramatic sources of pollution and non-aesthetic disturbance of aquatic life and therefore represent a potential risk of bioaccumulation that can affect living species.It is imperative to reduce or eliminate these dyes from liquid effluents with innovative biomaterials and methods.Therefore,this research aims to highlight the performance of Capparis spinosa L waste-activated carbon(CSLW-AC)adsorbent to remove crystal violet(CV)from an aqueous solution.The mechanism of CV adsorption on CSLW-AC was evaluated based on the coupling of experimental data and different characterization techniques.The efficiency of the CSLW-AC material reflected by the equilibrium adsorption capacity of CV could reach more than 195.671 mg·g^(–1) when 0.5 g·L^(–1) of CSLW-AC(Particle size≤250μm)is introduced into the CV of initial concentration of 100 mg·L^(–1) at pH 6 and temperature 65℃ and in the presence of potassium ions after 60 min of contact time according to the one parameter at a time studies.The adsorption behavior of CV on CSLW-AC was found to be consistent with the pseudo-second-order kinetic model and Frumkin's linear isothermal model.The thermodynamic aspects indicate that the process is physical,spontaneous,and endothermic.The optimization of the process by the Box Behnken design of experiments resulted in an adsorption capacity approaching 183.544 mg·g^(–1)([CV]=100 mg·L^(–1) and[CSLW-AC]=0.5 g·L^(–1) at 35 min).The results of the Lactuca sativa seeds germination in treated CV(70%),adsorbent solvent and thermal regeneration(more than 5 cycles),and process cost analysis(1.0484 USD·L^(–1))tests are encouraging and promising for future exploitations of the CSLW-AC material in different industrial fields.
文摘AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure(IOP) reduction($/mm Hg).METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction($/mm Hg) at 1y postoperatively.RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy, $284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy, $338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant, $351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy.CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method.
文摘BACKGROUND Laparoscopic Heller myotomy(LHM)has been the traditional surgical treatment for achalasia.Recently,peroral endoscopic myotomy(POEM)has demonstrated similar clinical outcomes with shorter procedure times.Studies comparing the direct cost-effectiveness of POEM vs LHM are limited.AIM To compare costs of POEM vs LHM.METHODS Haider SA et al.Comparing costs:POEM vs Heller myotomy WJGE https://www.wjgnet.com 594 October 16,2023 Volume 15 Issue 10 This retrospective chart review aimed to compare the outcomes and cost of clinical care between patients who underwent POEM and LHM procedures for achalasia.The study was conducted at a tertiary academic center from January 2019 to December 2020.Clinical outcomes,including post-operative Eckardt scores and adverse events,were assessed and compared between the two groups.Direct cost variance analysis was utilized to evaluate the cost of clinical care incurred by patients undergoing POEM in the year preceding the procedure,during the index admission,and one year post-procedure,in comparison to patients undergoing LHM.RESULTS Of 30 patients were included(15 POEM and 15 LHM)in the study.Patients in the POEM group had a mean Eckardt score of 0.5±0.5 post-procedure,which was no different from patients in the LHM group(0.7±0.6,P=0.17)indicating comparative efficacy.However,the total costs of the admission for the procedure in the LHM group were on average$1827 more expensive than in the POEM group(P<0.01).Total healthcare costs one year prior to index procedure were$7777 higher in the LHM group,but not statistically different(P=0.34).The patients in the LHM group one year after the index procedure had accrued$19730.24 larger total cost,although this was not statistically different from POEM group(P=0.68).CONCLUSION Despite similar clinical outcomes,the cost of the index procedure admission for POEM was significantly lower than for LHM.The difference was primarily related to shorter time increments utilized in the operating room during the index procedure,and shorter length of hospital stay following POEM.
基金The Science and Technology Project of Jiangsu Provincial Communications Department(No.7621000078)
文摘Pavement performance and economic efficiency are researched on the perpetual test pavement of Yijiang-Suzhou Express Highway in Jiangsu province, China. Test sections were continuously monitored. The conditions and developing laws of deflection, rutting and cracking are compared among the perpetual pavement with the rich binder layer (RBL), the perpetual pavement without the RBL, and the conventional semi-rigid asphalt pavement in the past eight years after opening for traffic. Economical evaluation is conducted via life cycle cost analysis (LCCA). Based on the performance comparison and LCCA analysis, sections with the RBL have good crack resistance, but they are not very satisfactory in the aspect of permanent deformation; the conventional semi-rigid asphalt pavement is the least economic one due to requiring more frequent maintenance. Research results show that the perpetual pavement without RBL is a more appropriate structure for the test site.
文摘Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.
基金Supported by the Natural Science Foundation of China(11201428,11471286,11701518)the Natural Science Foundation of Zhejiang Province(Y6110091)the Graduate Innovation Project of Zhejiang Sci-Tech University(YCX12001,YCX13005)
文摘In this paper,a new price is given to the online decision maker at the beginning of each day.The trader must decide how many items to purchase according to the current price.We present three variants and an online algorithm based on cost function.The competitive ratio of the online algorithm is given for each variant,which is a performance measure of an online algorithm.More importantly,we show that the online algorithm is optimal.
文摘AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations.METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level Ⅰ trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation(LOI), patients were divided in three groups(Group I, < 2 wk; Group Ⅱ, 2-3 wk; and Group Ⅲ, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100°(from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed.RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d(median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d(median 57 d; range 10-351 d). Group Ⅲ(prolonged immobilisation) had a statistically significant worse outcome in comparison to Group Ⅰ?and Ⅱ(P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups Ⅰ?and Ⅱ(P = 0.30). No statistically significantdifference in the direct medical costs between the groups was identified.CONCLUSION: The length of elbow immobilization doesn't influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome.
文摘Accurate cost estimation at the early stage of a construction project is key factor in a project’s success. But it is difficult to quickly and accurately estimate construction costs at the planning stage, when drawings, documentation and the like are still incomplete. As such, various techniques have been applied to accurately estimate construction costs at an early stage, when project information is limited. While the various techniques have their pros and cons, there has been little effort made to determine the best technique in terms of cost estimating performance. The objective of this research is to compare the accuracy of three estimating techniques (regression analysis (RA), neural network (NN), and support vector machine techniques (SVM)) by performing estimations of construction costs. By comparing the accuracy of these techniques using historical cost data, it was found that NN model showed more accurate estimation results than the RA and SVM models. Consequently, it is determined that NN model is most suitable for estimating the cost of school building projects.
文摘Agroforestry and beekeeping are widely promoted as prospective Nature-</span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Based Income Generating Activities (NIGAs) to improve livelihoods while at </span><span style="font-family:Verdana;">the same time enhancing biodiversity conservation in degrading</span><span style="font-family:Verdana;"> agro-ecologies. These activities can diversify and increase famers’ incomes and support in</span><span style="font-family:Verdana;">stinctive biota and fauna resilience. However, evidence to showcase and compare their long-term benefits is scant. We use the case of Uluguru</span><span style="font-family:Verdana;"> Mountains in Tanzania to evaluate and compare viability of agroforestry and beekeeping projects using the Cost</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Benefit Analysis (CBA) approach. The results of analysis yielded positive NPVs for both agroforestry and beekeeping projects at discount rates not higher than 8.2% and 8.5% respectively. Overall, the comparison of economic viability between agroforestry and beekeeping projects revealed that the former was relatively more profitable than the later in terms of both the NPV and Benefit</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Cost Ratio (BCR) criteria. However, the Internal Rate of Return (IRR) for beekeeping was slightly higher than that of agroforestry. Yet, we underscore the fact that these two projects can jointly be implemented to enhance livelihoods of farmers and support biodiversity conservation in the study </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">area </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and other parts with similar agro-ecologies in developing countries. However, farmers in these agro-ecologies need to be supported by governments and non-government development partners in terms of training and inspiration to shift from orthodox farming to sustainable NIGAs.
文摘Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.
文摘This study analyzes the sample influx (samples per case file) into forensic science laboratory (FSL) and the corresponding analysis costs and uses arbitrary re-sampling plans to establish the minimum cost function. The demand for forensic analysis increased for all disciplines, especially biology/DNA between 2014 and 2015. While the average distribution of case files was about 42.5%, 40.6% and 17% for the three disciplines, the distribution of samples was rather different being 12%, 82.5% and 5.5% for samples requiring forensic biology, chemistry and toxicology analysis, respectively. Results show that most of the analysis workload was on forensic chemistry analysis. The cost of analysis for case files and the corresponding sample influx varied in the ratio of 35:6:1 and 28:12:1 for forensic chemistry, biology/DNA and toxicology for year 2014 for 2015, respectively. In the two consecutive years, the cost for forensic chemistry analysis was comparatively very high, necessitating re-sampling. The time series of sample influx in all disciplines are strongly stochastic, with higher magnitude for chemistry, biology/DNA and toxicology, in this order. The PDFs of sample influx data are highly skewed to the right, especially forensic toxicology and biology/DNA with peaks at 1 and 3 samples per case file. The arbitrary re-sampling plans were best suited to forensic chemistry case files (where re-sampling conditions apply). The locus of arbitrary number of samples to take from the submitted forensic samples was used to establish the minimum and scientifically acceptable samples by applying minimization function developed in this paper. The cost minimization function was also developed based on the average cost per sample and choice of re-sampling plans depending on the range of sample influx, from which the savings were determined and maximized. Thus, the study gives a forensic scientist a business model and scientific decision making tool on minimum number of samples to analyze focusing on savings on analysis cost.
文摘Implementing effective cost management approaches has recently gained momentum due to intense competition and increasing customer demands. Moreover, effective cost management approaches have contributed to firms' competitive advantage in relation to cost leadership strategy. Consequently, firms have implemented contemporary cost management systems, such as activity-based management, business process re-engineering, life-cycle costing, target costing, and theory of constraint (TOC), to enable them to become low-cost producers and compete effectively and sustain their performance. Furthermore, focusing on cost management to improve profitability has led to the integration of activity-based costing (ABC) and TOC. Therefore, the aim of this study is to review literature and discuss how integration of ABC and TOC can result in improved and sustained cost management. While these methods have different approaches in addressing cost management, treating them as complementary cost management approaches can result in improved cost management due to improved product costing, improved cost reporting, improved product-mix decisions, and improved cycle-time management. Improvement in cost management will then result in sustained cost management. Sustained cost management is further enhanced with the investment in information customer and shareholder value technology that supports cross-functional decision making to continue creating to remain competitive in the market.
基金National Natural Science Foundation of China (No 10571134)
文摘Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups). Results from the output-oriented BCC model show that Treatment 4 ( 600 mg of zidovudine plus 400 mg of didanosine plus 400 mg of nevirapine) is particularly efficient for age group 14—25, but not efficient for the older age groups; Treatment 1 (600 mg of zidovudine alternating monthly with 400 mg of didanosine)and Treatment 2 (600 mg of zidovudine plus 2.25 mg of zalcitabine) are efficient for the age groups 35—45 and 45— ; age group 25—35 does not have a particularly efficient treatment, but Treatments 1 and 2 are relatively good. The cost efficiency BCC model, which takes the treatment cost into account, gives similar results as the output-oriented model. Results from the indirect output-oriented BCC model, which allows the replacement among medicines, show that the efficiency of Treatment 2 has greatly decreased compared with that of the output-oriented model, and a set of optimal medicine amounts for different age groups is obtained.
文摘Parabolic trough collectors (PTCs) are employed for a variety of applications including steam generation and hot water generation. This paper deals with the experimental results and an economic analysis of a new fibre reinforced plastic (FRP) based solar PTC with an embedded electronic controlled tracking system designed and developed for hot water generation in a restaurant in Madurai, India. The new collector performance has been tested according to ASHRAE Standard 93 (1986). The performance of a new PTC hot water generation system with a well mixed hot water storage tank is investigated by a series of extensive tests over ten months period. The average maximum storage tank water temperature observed was 74.91℃, when no energy is withdrawn from the tank to the load during the collection period. The total cost of the new economic FRP based solar PTC for hot water generation with an embedded electronic controlled tracking system is Rs. 25000 (US$ 573) only. In the present work, life cycle savings (LCS) method is employed for a detailed economic analysis of the PTC system. A computer program is used as a tool for the economic analysis. The present worth of life cycle solar savings is evaluated for the new solar PTC hot water generation system that replaces an existing electric water heating system in the restaurant and attains a value of Rs. 23171.66 after 15 years, which is a significant saving. The LCS method and the MATLAB computer simulation program presented in this paper can be used to estimate the LCS of other renewable energy systems.
基金support provided by the National Science Fund for Distinguished Young Scholars(52325703)Postdoctoral Innovation Talents Support Program(BX20220066)+1 种基金China Postdoctoral Science Foundation(2022M720709)State Key Laboratory of Power System Operation and Control(SKLD23KM06).
文摘Scaling up clean hydrogen supply in the near future is critical to achieving China’s hydrogen development target.This study established an electrolytic hydrogen development mechanism considering the generation mix and operation optimization of power systems with access to hydrogen.Based on the incremental cost principle,we quantified the provincial and national clean hydrogen production cost performance levels in 2030.The results indicated that this mechanism could effectively reduce the production cost of clean hydrogen in most provinces,with a national average value of less than 2 USD·kg^(-1) at the 40-megaton hydrogen supply scale.Provincial cooperation via power transmission lines could further reduce the production cost to 1.72 USD·kg^(-1).However,performance is affected by the potential distribution of hydrogen demand.From the supply side,competitiveness of the mechanism is limited to clean hydrogen production,while from the demand side,it could help electrolytic hydrogen fulfil a more significant role.This study could provide a solution for the ambitious development of renewables and the hydrogen economy in China.
基金the National Natural Science Foundation of China(72203214 and 72061147002)China Scholarship Council(CSC)(201913043)。
文摘Excessive consumption of refined grains harms human health and ecosystem viability.Whole grains,as a healthy and sustainable alternative to refined grains,can benefit individual health by providing dietary fiber,B vitamins,and bioactive substances.Additionally,they aid in improving the environment due to their higher extraction rate and lower carbon emission during the processing stage.However,few studies have attempted to evaluate the economic and social benefits of increasing the amount of whole grain in grain intake.This paper estimates the potential savings in healthcare costs and reduced food carbon footprints(CFs)that could result from a shift toward whole grain consumption following the Chinese Dietary Guidelines(CDG).We investigate hypothetical scenarios where a certain proportion(5–100%)of Chinese adults could increase their whole grain intakes as proposed by CDG to meet the average shortfall of 30.2 g.In that case,the healthcare costs for associated diseases(e.g.,type2 diabetes mellitus(T2DM),cardiovascular disease(CVD),and colorectal cancer(CRC))are expected to reduce by a substantial amount,from USD 2.82 to 56.37 billion;the carbon emission levels are also projected to decrease by0.24–5.72 million tons.This study provides compelling evidence that advocating for the transition towards greater consumption of whole grain products could benefit individual health,the environment,and society,by reducing both healthcare costs and carbon emissions.
文摘AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid(TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients(control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients(TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken. RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender(P = 0.47), proportion of total hip replacement to total knee replacement(P = 0.25) or pre-operative haemoglobin(P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2%(P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group(P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group(P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.